


Causality

by apolesen



Series: Adventures in Cardassian medicine [3]
Category: Star Trek: Deep Space Nine
Genre: Alien Biology, Background Poly, Friendship, Gen, M/M, Medicine, Post-Canon Cardassia, Pregnancy, Pregnancy complications, See notes for full tw list
Language: English
Status: Completed
Published: 2020-01-29
Updated: 2020-01-29
Packaged: 2021-02-27 12:00:29
Rating: Teen And Up Audiences
Warnings: No Archive Warnings Apply
Chapters: 1
Words: 4,094
Publisher: archiveofourown.org
Story URL: https://archiveofourown.org/works/22456855
Author URL: https://archiveofourown.org/users/apolesen/pseuds/apolesen
Summary: Bashir shadows Parmak at the non-emergency clinic to brush up on his Cardassian medicine. One case in particular drives home how far-reaching the effects of the Dominion's bombardment is and might remain in the future.
Relationships: Elim Garak/Kelas Parmak, Julian Bashir & Kelas Parmak, Julian Bashir/Elim Garak
Series: Adventures in Cardassian medicine [3]
Series URL: https://archiveofourown.org/series/1690147
Comments: 6
Kudos: 64





	Causality

**Author's Note:**

> Full list of trigger warnings: aftermath of large-scale catastrophe (the Fire), pregnancy complications, discussion of congenital conditions and death, mention of abortion.

During his first few months on Cardassia Prime, Bashir’s experience had almost exclusively been with emergency medicine. It was the kind of high-pressure work he enjoyed, but after fifteen weeks of only treating the most serious cases in the Union Capital, even he had started fraying at the edges. It had been Parmak who suggested a change of pace. After some discussion and a fair bit of negotiation, they had agreed that Bashir would shadow Parmak at the non-emergency clinic a few days a week. It was uncommon to see Parmak embarrassed, but he did look uncomfortable when he said: 

‘It may be good for you to see other types of patients.’ 

Bashir was quick to agree. Emergency surgery was one thing – he was adept enough to be able to patch up people of species he had barely seen before – but general medicine was quite another. For most of his career, his Cardassian patients had skewed strongly towards the old and the male. Since he got to Prime, he had read every medical textbook he could get hold of, but it was not the same as practicing. 

His previous impression of Cardassian healthcare had been that it was, if nothing else, efficient. That word could not be used of the clinic. There was the bare minimum of triage. No information was taken about the patients before they were seen. The queue was done by handing out tallies. 

‘Can’t we make them fill out some form while they wait?’ Bashir asked. Parmak shook his head. 

‘Most of them can’t read or write.’ 

In the past, that would have surprised Bashir, but he had been on Cardassia Prime long enough to become accustomed to the poor conditions. Perhaps when the worst was over, they could set up schools. But that was still far away. 

Parmak and Bashir quickly found a routine at the clinic. Bashir would fetch the patients and assist Parmak. On occasion, he would perform examinations or procedures, but most of the time he deferred to his Cardassian colleague. At times, Parmak asked if he would not prefer to work on his own, but Bashir always said no. Watching someone more experienced was good for him. 

That day, the waiting room was particularly crowded. The seats were all taken. Some patients sat on the floor, while others half-lay, leaning against the knees of those on the chairs and benches. Whenever Bashir entered to call out a number, the newcomers would stare. Few had ever seen a human. Most did not comment on it, but their last patient of the day was one of the exceptions. When her number was called and her husband had helped her to her feet, the woman gave Bashir a long look and said: 

‘You’re not Bajoran, are you?’ 

The question caught him off guard. 

‘I’m not,’ he said. ‘I’m human.’ 

The woman raised her brow-ridges. 

‘I thought humans were smaller.’ 

‘Some are,’ Bashir said, collecting himself. ‘What’s your name?’ 

‘Mrs Natak,’ she said. 

Bashir nodded. 

‘Will you come through?’ 

She looked him up and down again, then gathered her skirts and followed him. She looked to be in her thirties or forties. Her gait made it easy to tell that she was gravid, although at a glance, Bashir could not tell how far along she was. 

When they reached the door to the consultation room, Bashir knocked before stepping in. He held the door open as the patient stepped through. 

‘Mrs Natak, this is Doctor Parmak,’ he said. She bowed her head briefly in greeting. 

‘Good evening.’ 

Parmak smiled at her. 

‘You’ve met Doctor Bashir,’ he said. Mrs Natak looked at her. 

‘You’re a bit young to be a doctor, aren’t you?’ she asked. Bashir was not sure what to say. ‘I suppose they might do things differently in the Federation,’ she added. 

‘Would you be more comfortable just speaking to Doctor Parmak?’ Bashir asked. 

Mrs Natak shook her head and sat down. 

‘No need for that. I’ve laid six eggs. I’m not easily embarrassed.’ 

Parmak smiled, clearly amused. 

‘Well then,’ he said, taking his seat. ‘What brings you here?’ 

She put her hand on her stomach. 

‘This. I thought I was twelve days gone, but I’m feeling ready to burst. I think I must have gotten it wrong.’ 

‘This is your seventh egg?’  
‘Yes.’ 

‘Alright.’ Parmak got to his feet. ‘Let’s have a look. Loosen your clothing and lie down, please.’

Mrs Natak found the clasps and laces of her clothes, then lay down on the table Parmak had indicated, pulling her skirts and tunic aside to expose her belly. Bashir watched as Parmak examined her, pressing his hands against her abdomen to feel the hardness of the shell inside her. 

Eventually, he removed his hands. 

‘Twelve days sounds right to me.’ 

‘Are you sure?’ Mrs Natak asked, looking up at him. Parmak smiled. 

‘Yes. You are definitely not further along than fourteen days, and I’d say you are past day eleven.’ 

‘But it’s so large,’ she said. 

‘It is larger than we’d expect at this point,’ Parmak said. ‘Doctor Bashir, would you please get the tape-measure?’ 

Bashir retrieved it from Parmak’s medkit, sending a grateful thought to Garak who had relinquished it from his sewing-kit when Parmak’s old one had been lost a few weeks ago. He offered it to Parmak, but he stepped aside, making a gesture for him to go ahead. Bashir approached the table. 

‘Would you mind if I measure your egg?’ 

She looked perplexed. 

‘Should I?’ 

Not for the first time during this appointment, Bashir felt some amount of culture shock. Most Cardassians were not used to the idea of informed consent. His instinct was to explain the procedure, but he fought it. Instead he glanced over at Parmak, who gave him a brief nod to go ahead. When he first touched her, she made a small surprised sound. 

‘Your hands are very warm,’ she said. 

‘Is it uncomfortable?’ Bashir asked, pausing. Mrs Natak shook her head. 

‘No. Not at all. Do what you have to do.’ 

Bashir felt her abdomen until he found the top of the egg, further up than he had expected it. He measured from that point to the edge of her _chuva_ , just visible at her unlaced waistband. He read the number on the tape-measure. Parmak gave him a questioning look. 

‘Forty-eight _trems_ ,’ Bashir said. Roughly 15.8 centimetres. Parmak stepped forward and took the tape-measure from him. With used motions, he retook the measurement. Bashir was expecting to find he had made some mistake, but Parmak’s claw marked the same point on the tape-measure. A crease deepened between Parmak’s brow-ridges.

‘Is that a lot?’ Mrs Natak asked, pushing herself up onto her elbows. 

‘It is,’ Parmak said. ‘Have your previous eggs been particularly large?’ 

‘Oh yes,’ she said. ‘All of them. My mother’s were the same. With my first one, I almost split.’ 

‘Do you know how large?’ he asked. ‘Did they measure the circumference when they were laid?’ 

‘I suppose they did,’ she said. ‘I can’t remember though.’ 

Parmak nodded, brow still furrowed. 

‘I see,’ he said. ‘What I think we should do is do a scan of the egg, so we can have a look inside it.’ 

For the first time since arriving, Mrs Natak looked nervous. 

‘Will it hurt?’ 

Parmak shook his head and smiled. 

‘No. All we’re going to do is place the scanner against your stomach. I might have to press a little to be able to get a good look at the yolk, but it won’t hurt.’ 

She relaxed a little. 

‘Alright.’ 

Bashir picked out the right scanner and handed it to Parmak, then stepped back. Mrs Natak looked over at him and smiled. He smiled back. 

‘He’s a funny one, your student,’ she said to Parmak. ‘I’ve never seen anyone with such a smooth face.’ 

Parmak smiled and hummed something in agreement before going back to looking at the scanner. Bashir watched how he pressed the scanner harder and moved it in different angles. The smile was fading now, and instead he had a look of professional neutrality on his face. 

Eventually he removed the scanner. 

‘We’re all done. You can get dressed.’ 

As the patient fastened her clothes again, Bashir caught Parmak’s eye. He looked away almost at once, but Bashir caught sight of concern. Parmak did not sit down until Mrs Natak took a seat. Bashir sat down too, but moved his chair back a little.

Parmak leaned forward a little and looked his patient in the eye. 

‘Mrs Natak,’ he said. ‘I’m afraid it’s bad news.’ 

She paled. Her hand went to her stomach. 

‘Is it dead?’ she whispered. Parmak shook his head slowly, but with no joy. 

‘No.’ He picked up the scanner and and called up the images he had just captured. ‘This is the yolk of your egg. When we look at images like this, we look for the embryonic disc, which is what will grow to be the hatchling.’ He pointed with the dull point of his claw. ‘There are two embryonic discs in your egg. One here, and another here.’ 

Mrs Natak stared at the screen. She opened her mouth wide and smacked her hand over it. A low wail still escaped her. 

‘No,’ she cried. ‘Not that.’ She slumped over, sobbing. Bashir looked over at Parmak. His face was still schooled into a look of detached compassion, but the pain was clear in his eyes. 

‘I’m so very sorry,’ he said. He was about to say something more, but Mrs Natak did not seem to notice.

‘No, no, no,’ she said, over and over until the words were lost in her sobs. Parmak drew a slow breath, as if to maintain his composure. He leaned forward so that he was level with Mrs Natak, who was doubled over. 

‘Is there someone we can contact for you?’ 

She straightened up faster than Bashir would have expected possible. She drew her fingers across her face, smearing the blue dye from her _chufa_. It looked almost intentional, like some ritual, but then he realised that she was trying to wipe her tears away. 

‘My– my husband,’ she stuttered. ‘He came with me – he is outside…’ If there was more, it was lost in the onslaught of sobs. Parmak looked over at Bashir. He did not have to say anything. Bashir got up and left in silence. He could hear her wails from outside the examination room. As he walked down the corridor, they faded. He made a mental note of when he could not hear it anymore. 

When he entered the waiting-room, many faces turned to look at him expectantly. The man Bashir had seen help Mrs Natak up only minutes before, however, was absorbed in his own thoughts. 

‘Mr Natak?’ 

He jumped at the sound of his own name. Then, collecting himself, he picked his way through the people who sat on the floor. 

‘That’s me.’ 

‘I’m Doctor Bashir. If you could come with me, please,’ Bashir said, forcing a smile. Mr Natak did not smile back. He watched him with wide-eyed confusion.

‘Has something happened to my wife?’ he asked as they started walking. Bashir stalled until they were far enough from the waiting room to not be overheard, then stopped and faced Mr Natak. 

‘Your wife is in good hands, but she has asked for you.’

‘Why?’ he asked, eyes even wider. ‘Is something wrong with the egg?’ 

For a moment, Bashir was at a loss. He did not know to answer – vague reassurance or delicate evasion?

‘I am not your wife’s doctor, Mr Natak,’ he said gently. ‘Doctor Parmak is with her now. Let me take you there.’ 

Mr Natak nodded. His whole face was tense with fear. Bashir smiled encouragingly, feeling like a liar. His instinct had been to say something to prepare the man for the state his wife was in, but he could not think of anything. For the first time in several months, he felt that his Cardassian was too rudimentary. All he could do was to gesture to Mr Natak to follow him. They passed the point that Bashir had noted before. A few more footsteps, and he could hear wailing. He kept looking forward. Glancing over at the husband would give it away. Even without looking at him, Bashir could sense how he was getting more nervous. They were drawing closer to the door. 

‘That… isn’t her, is it?’ His voice trembled. Bashir hesitated, then turned to him. 

‘It is,’ he said. ‘Your wife is quite upset. She needs your support.’ 

Mr Natak looked at him with wide eyes, struggling to speak. Forcefully, he swallowed. 

‘Alright,’ he whispered. 

Bashir stepped up to the door and knocked. He waited for a moment, then opened it. The sound of her sobs hit against him. She was almost bent double, so lost in her anguish that she did not notice the door. Parmak had been sitting with his hand on her shoulder. Now, he gently removed it. 

‘Mrs Natak, your husband is here.’ His voice was soft, like at a death-bed. 

She looked up. For a moment, her face was blank, as if she had quite forgotten what was happening. Then it crumbled. She said something – a name? – but Bashir could not make it out. Mr Natak rushed to her. 

‘Zeral, what is wrong? What’s happened?’ 

She could not speak. All that came out of her mouth was a high-pitched keening. Her husband wrapped his arms around her, weeping too. 

‘Zeral, Zeral, what happened to you?’ 

Parmak raised his gaze from the couple. It was not until it came to rest on him that Bashir realised that he had frozen up. Quietly, he stepped back into the corridor and closed the door. His throat ached. He took a deep breath. It would do no good for him to cry too. 

With no orders on what to do, he headed to the room set aside for the staff. He washed his hands, going through the steps of rubbing, rinsing and drying without thinking. The consultation room was almost on the opposite side of the building, but the sound of the woman’s sobs was stuck in his head. There were many people waiting to be seen – perhaps he should take care of the next patient. Parmak would be a while, but no one would mind if he saw patients on his own. 

Even while thinking that, his feet steered in the opposite direction, taking him to the table where the staff would have their meals. He sat down with a thud. Since he came to Cardassia, he had heard so many people weep and scream, and none of it had affected him like this. He had been taught how to put things aside, to compartmentalise whatever reaction he might have. There had been times in the past when he had struggled to maintain that professional composure, yes, but that had always been when the patient was his friend. He had never met Mrs Natak before today. 

And yet he sat here, unsettled and confused. Piece by piece, he picked apart what he felt. Her reaction had been sudden and violent. It had startled him. The husband’s fretful worry had made him feel guilty. Leaving Parmak in that room made him feel like he had fled. But most of all, he had not understood what had happened. Parmak had not even had to give any details for the patient to understand. Bashir, on the other hand, with his brilliant mind and excellent qualifications, did not have the slightest idea of what was going on. He sighed in frustration. After all this time, he was still as arrogant as he had been when he was fresh out of med-school.

The door to the staff-room opened. Footstep. Footstep – _tap_. Footstep. Footstep – _tap_. Then a sigh and the sound of Parmak sinking into a chair. Bashir looked over at him. Parmak did not speak at first, just turning his cane in his hand and staring into thin air. He looked exhausted. 

‘That’s the third in a month,’ he said. ‘There must be a reason. Some contamination from the Jem’Hadar weapons, perhaps…’ He trailed off. 

‘Parmak…’ 

‘I know,’ Parmak said. ‘It’s not enough to draw conclusions on, but even three is a significant number.’ 

‘No, Parmak, slow down,’ Bashir said. ‘I don’t understand.’ 

The Cardassian doctor looked up, confused. 

‘Explain it to me,’ Bashir said. ‘Why did she react like that?’ 

Parmak rubbed his eyes. 

‘There were two embryonic discs in the egg.’ 

‘So she’s expecting twins. Why is that bad?’ 

A flash of annoyance passed over Parmak’s face, but almost at once it gave way to exhaustion. 

‘What is the expected fundal height at eleven day’s gestation?’ 

Thirteen point three centimetres, his mind supplied. The same measurement in _trems_ appeared almost simultaneously. 

‘Forty point four,’ he said. ‘Hers was forty-eight. That’s over eighteen per cent larger than expected.’ 

Parmak nodded sadly. 

‘In the cases where the gravidity comes to term, the egg is almost forty per cent larger than the average.’ 

‘Forty per cent?’ Bashir repeated, shocked. He put together the information Parmak had just given him, envisioning a graph. If the progression was steady, the egg would be the size the average one would be when it was laid by day fourteen, a week before oviposition usually took place. ‘The risk of the shell-gland rupturing must be considerable.’ He did not need to be told what that might lead to. Haemorrhage, shock, potential damage to other organs.

‘It is. In cases with no intervention, only a third survive to lay the egg.’ 

‘It must be a very dangerous laying,’ he said. ‘How common is it for the oviposition to succeed?’

‘Twenty-five percent. But in most of those cases, the trauma to the mother is extensive.’

‘Is the egg at all viable?’ 

Parmak sighed. His stoop seemed more pronounced than before. 

‘There is not enough oxygen in the egg for both hatchlings. If they do survive, they will have severe brain damage. But it is rare. Often, such an egg will never hatch. If one of the hatchlings dies, the other will die too, once… decomposition sets in.’

For a moment, Bashir was lost for words. 

’And the other seventy-five percent?’ 

‘Either an ootomy is performed – a careful removal of the egg – or the mother dies before that decision is made,’ Parmak said. ‘But it should not be allowed to get to that point.’ 

‘So what will happen with Mrs Natak?’ 

‘I’ve had her admitted,’ Parmak said. ‘We will run some more detailed scans to corroborate the findings. Once that is done, we will abort the egg. The risks are too great.’ 

Bashir nodded in agreement.  
‘Will she be alright?’ 

‘Yes,’ Parmak said. ‘She will be able to conceive again in a month or two.’ 

‘Do you think she knew that?’ Her reaction had been so violent, after all. 

Parmak sighed. 

‘Most probably not. Most people still see it as something catastrophic. It used to be, a long time ago, and of course, without intervention, it still is. It’s just a good thing she trusted her instinct and came in when she did. A few days longer and she might have been in real danger.’ He looked down at his hands, as he interwove his fingers and then undid them. ‘That might not be much of a comfort for her, as things are.’

Bashir nodded. Finding out that the child one had hoped for would not live was difficult in any situation. In a world like this one, filled with ruins and decay, where the promise of a child might be a great comfort, it must be devastating. 

It occurred to him now that her reaction might not just have been about that, though. 

‘Are there superstitions about twins?’ he asked.

Parmak nodded. 

‘It is generally seen as a bad omen. Specifically it is seen as a sign that someone in the family – not even the parents in question – has done something to displease the ancestors.’ 

_The past generation punishing the present generation through the future generation,_ Bashir thought bitterly. _How Cardassian._

But he decided not to express that. Parmak was looking concerned again, lost in thoughts.

‘You said this is the third case this month,’ Bashir said. 

‘Yes,’ he said, shaking himself, ‘that I’ve seen.’ 

‘Is it usually rare, then?’ 

Parmak nodded. 

‘One in every three-thousand gravidities is the most generous estimate.’ 

‘That _is_ rare. The rate among humans is one in eighty births.’ 

Parmak raised his brow-ridges. 

‘That’s even more common than among Bajorans.’ 

Getting back to the matter at hand, Bashir asked: 

‘How many gravid patients have you seen in the last month?’ 

‘I couldn’t say,’ Parmak said. ‘But it’s much less than nine thousand. I think I’ve seen more vitelline abnormalities than before too. But maybe it’s just that we are not able to do the kind of screenings we would do usually, so that complications that would otherwise be found early are allowed to become worse…’ 

For the first time, Bashir heard something like panic in his voice. He was not sure if it was the right thing to do, but he pushed aside his uncertainty and put his hand on Parmak’s arm. Parmak smiled and for a moment covered his hand. Then he gently shook off his grip.

‘It’s possible the Dominion weapons had teratogenic side-effects,’ Bashir said. ‘It could even be intentional. They haven’t hesitated to use bioweapons before.’ 

Parmak took off his glasses to rub his eyes, and Bashir wished he had not spoken. They were not equipped to deal with anything of this magnitude. The clinic had nothing over level-3 scanners, most of them badly maintained. At times it was a better idea to rely on more rudimentary instruments and one’s own senses. The hospital as a whole had two level-5 scanners. They might have to wait hours, even days, to use one. As so often, Bashir thought of the resources of Starfleet. Just one hospital ship in orbit would make a huge difference. Even a portable genetic analyser would make it possible for them to do far more.

‘We should look at the numbers first,’ Bashir said. Short-term goals seemed like the best approach. ‘It could still be coincidence.’ 

‘Perhaps,’ Parmak said, sounding unconvinced. He took a deep breath and looked Bashir in the eye. ‘Go home. It’s been a long day.’ 

‘You’re staying then?’ Bashir asked. Parmak nodded. 

‘Mrs Natak’s procedure can’t wait.’ 

‘I can stay if you want.’ 

Parmak shook his head. 

‘There is no need. Besides, Elim should be told I won’t be home tonight.’ 

Bashir hesitated. He could already see the pinched look that would spread on Garak’s face when he saw only one of his lovers returning. Whenever one of them had to stay behind at the hospital, Garak became restless with worry. More than once when Bashir had been the one to stay longer than expected, Garak had turned up with a container of _aytlik_ broth for him. Bashir thought that Parmak looked like he would need that kind of gesture tonight. He might mention it to Garak. 

He stood up.

‘I’ll see you in the morning, then.’ 

‘Wait.’ Parmak held up a hand. Reaching into his pocket, he retrieved a notebook. ‘I’ve tried to make notes on every patient I’ve seen,’ he said. ‘I can’t guarantee that it’s every single one, but it should be accurate enough for a statistical analysis.’ 

Bashir took the notebook and opened it. Parmak’s small, dense handwriting filled up the pages. He had to concentrate to read it, but with some effort, he could make meaning out of the writing. 

‘I’ll see what I can do,’ he said, putting it securely in his own pocket. He gave Parmak’s shoulder a squeeze. ‘Good luck.’ 

Parmak bowed his head, acknowledging what he had said. 

‘Good night, Bashir.’ 

Bashir smiled, not sure what more to say. He put on his coat and his respirator and set off. On his way home, he kept his hand on Parmak’s notebook. He would spend the evening going through it, tallying incidents of vitelline abnormalities and congenital defects against cases without pathology. He hoped he would find nothing, but he doubted it. _Knowing is better than ignorance,_ he told himself, although it did not feel true. The ruins of Cardassia Prime seemed to loom over him, stretching into the future, affecting lives not yet lived. There was little the two of them could do – for now, at least.


End file.
